Intractable Emesis in Children: A Pediatrician’s Unusual Dilemma. A Case Report and Review of The Literature.

Abstract

Noor Abdullah Yahya and Reem Alketbi

Wilkie’s syndrome, commonly referred to as Superior mesenteric artery syndrome, is an unusual encounter in the medical field. It could mimic a simple gastritis in an acute setting to a more serious clinical suspicion of bowel obstruction or neoplasia on a chronic onset. While this syndrome most commonly happens as a sporadic case, it can be favored by genetic predisposition of a congenital short ligament of Trietz or when the superior mesenteric artery is more distal than normal on the abdominal aorta. Inciting medical factors can contribute to its etiology or simply, it could happen as a result of surgical complication. Recent literature reveals that the superior mesenteric artery may co-occur with other phenomena, such as Nutcracker syndrome, as both share similar anatomic levels. In our report, we describe a case of a 10-year-old boy of Middle Eastern descent who was brought to the emergency department with repeated vomiting that had started one month ago, accompanied by abdominal pain and change in bowel habits that was initially attributed to gastroenteritis. After multiple and failed conservative attempts from different pediatricians in the team, a contrast- enhanced abdominal CT confirmed the presence of superior mesenteric artery syndrome that happened as a result of rapid weight loss due to his gastroenteritis. Early diagnosis of superior mesenteric artery syndrome is a crucial step in its management to prevent serious health-related repercussions.

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